With a health care environment defined by complexity, uncertainty, and volatility, one thing is certain – CHANGE is inevitable. Like it or not, the next decade promises change of unprecedented magnitude in health care. Sometimes it is best to resist change, and sometimes to align with change, but always we should rise to the challenge, be leaders, and create the future. We must never forget that the future belongs to those who prepare today.

The discovery of anesthesia changed the world, and our specialty has evolved dramatically over the past few decades. Anesthesia practice and its scope have advanced and improved, in large part as a result of clinical and translational investigation, discovery of new drugs and technologies, and extension of our practice from the OR to the entire course of perioperative care. As a result of these advances, clinical practice has advanced and quality, safety, and outcomes have improved. Advances in anesthesia care have allowed patients to undergo innovative procedures safely, resulted in shorter lengths of hospital stay, and have facilitated the transition of care from hospitals to a variety of other settings. In short, we have impacted the lives of our patients and created new roles and opportunities for anesthesiologists throughout the health care system. But there are “burning platforms” such as cost structure, system fragmentation, quality and safety, and equity that we must address and overcome.

This supplement describes many of the critical issues of importance to anesthesiologists – and our communities – that we must address over the next decade. It focuses on the current and future state of anesthesiology from a clinical, research, and practice management perspective while also addressing important issues related to quality, safety, and access to care. It also considers broader issues impacting health care and anesthesia practices, including diversity, equity, and inclusion and the crisis in health care disparities that have become so glaring in the last year.

The next eight to 10 years are critical for our specialty and the important roles anesthesiologists have in perioperative medicine and beyond. The supplement provides a foundation upon which to address the challenges and opportunities for anesthesiology. Many of the articles are thought-provoking; some propose significant new approaches to defining the role of anesthesiologists in the health care system and how we can most effectively continue to advance the concept of value-based anesthesia care. You may not always agree with the authors, and some of the goals may be difficult to accomplish. We hope this collection of articles provides interesting ideas and approaches that clarify a vision around which impactful and durable change can take place to secure the future of physician-led anesthesiology and the health of our patients.